Italian Society of Endocrinology Consensus Statement: definition, evaluation and management of patients with mild primary hyperparathyroidism

Marcocci, Claudio; Brandi, Maria Luisa; Scillitani, Alfredo; Corbetta, Sabrina; Faggiano, Antongiulio; Gianotti, Laura; Migliaccio, Silvia; Minisola, Salvatore

doi:10.1007/s40618-015-0261-3

Cited by 46 publications

(16 citation statements)

References 89 publications

(130 reference statements)

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“…In clinical practice, the use of Ca/P has the potential of becoming a useful tool for the diagnosis of PHPT and might become an inexpensive, first‐line examination in the workup of PHPT, with serum PTH as a successive measurement, useful to confirm the diagnosis of PHPT when Ca/P is above 2.71 (3.5 if Ca and P are measured in mg/dL). It is well known that serum P alone is unreliable for diagnosing PHPT, and it is currently measured neither in clinical nor in research settings, with the exception of few studies, in accordance to clinical guidelines recommendations . Here we suggest that serum P should be measured together with Ca allowing calculating Ca/P to be inexpensive, and not requiring further technical equipment/skills beyond those already available for serum Ca measurement.…”

Section: Discussionmentioning

confidence: 81%

“…It is well known that serum P alone is unreliable for diagnosing PHPT, and it is currently measured neither in clinical (18) nor in research settings, with the exception of few studies, (35) in accordance to clinical guidelines recommendations. (8,(36)(37)(38) Here we suggest that serum P should be measured together with Ca allowing calculating Ca/P to be inexpensive, (39) and not requiring further technical equipment/ skills beyond those already available for serum Ca measurement.…”

Section: Discussionmentioning

confidence: 99%

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Serum Calcium to Phosphorous (Ca/P) Ratio Is a Simple, Inexpensive, and Accurate Tool in the Diagnosis of Primary Hyperparathyroidism

et al. 2017

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Primary hyperparathyroidism (PHPT) diagnosis is challenging and is based on serum calcium (Ca) and parathyroid hormone (PTH). Because serum Ca and phosphorous (P) are inversely related in PHPT, we investigated the diagnostic value of the serum Ca/P ratio in the diagnosis of PHPT. We report a single‐center, case‐controlled, retrospective study including 97 patients with documented PHPT and compared them with those of 96 controls (C). The main outcome measures were: serum PTH, 25‐OH vitamin D, Ca, P, albumin, and creatinine. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the serum Ca/P ratio were calculated. The results were verified using an independent, anonymous set of data extracted from a laboratory database containing over 900 million entries. A total of 35 (36.1%) PHPT patients had normocalcemic PHPT (NCHPT). Ca and PTH were significantly higher in PHPT than in C (p < 0.0001). P was significantly lower in PHPT than in C (p < 0.0001). The Ca/P ratio was significantly higher in PHPT than in C (p < 0.0001). Receiver‐operating characteristic (ROC) curves analyses identified a cutoff of 2.71 (3.5 if Ca and P are expressed in mg/dL) for Ca/P ratio with a sensitivity and specificity of 86% and 87%, respectively (p < 0.0001), confirmed by the independent, big data approach. In conclusion, Ca/P is a valuable tool for the diagnosis of PHPT and is of superior value compared to serum Ca alone, especially in NCPHT. Because Ca/P is simple, inexpensive, and easily accessible worldwide, this ratio is useful for PHPT diagnosis, especially in laboratory/medical settings relying on limited resources, such as low‐income countries. © 2017 The Authors. JBMR Plus is published by Wiley Periodicals, Inc. on behalf of the American Society for Bone and Mineral Research.

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Serum Calcium to Phosphorous (Ca/P) Ratio Is a Simple, Inexpensive, and Accurate Tool in the Diagnosis of Primary Hyperparathyroidism

et al. 2017

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“…Though genetic analysis of the genes involved in renal calcium handling might define the risk of kidney stones development in PHPT patients, data from controlled study are not yet available; 3. At present, genetic analysis is recommended only for the CASR gene mutations in all patients with calciumcreatinine clearance ratio less than 0.02, as it can help to distinguish FHH from PHPT (9).…”

Section: Vitamin D Receptor (Vdr)mentioning

confidence: 99%

MECHANISMS IN ENDOCRINOLOGY: Kidney involvement in patients with primary hyperparathyroidism: an update on clinical and molecular aspects

Verdelli

Corbetta

2017

European Journal of Endocrinology

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Primary hyperparathyroidism (PHPT) is the third most common endocrine disease. Kidney is a target of both chronic elevated PTH and calcium in PHPT. The classic PHPT complications of symptomatic kidney stones and nephrocalcinosis have become rare and the PHPT current presentation is asymptomatic with uncertain and long-lasting progression. Nonetheless, the routine use of imaging and of biochemical determinations have revealed the frequent occurrence of asymptomatic kidney stones, hypercalciuria and reduced kidney function in asymptomatic PHPT patients. Though the pathogenesis is far from being elucidated, PHPT is associated with reduced renal function, in terms of estimated glomerular filtration rate, and related increased morbidity and mortality. In the last decade, the effort of the Kidney Disease: Improving Global Outcomes (KDIGO) panel of experts highlighted that even mild reduction of kidney function is associated with increased risk of cardiovascular disease. These considerations provided the basis for the Fourth Workshop recommendations of a more extensive diagnostic workout about kidney features and of wider criteria for parathyroid surgery including asymptomatic kidney disease. Moreover, kidney involvement in PHPT is likely to be affected by variants of genes coding the key molecules regulating the calcium and ions renal handling; these features might have clinical relevance and should be considered both during diagnostic workout and follow-up. Finally, the effects of parathyroid surgery and of medical treatment on kidney involvement of PHPT are reviewed.

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“…The earliest case of PHPT was an asymptomatic normocalcemic 12-year-old girl. Patients with low levels of vitamin D were treated with oral supplements to exclude cases of secondary hyperparathyroidism [4].…”

Section: Resultsmentioning

confidence: 99%

MEN1 in children and adolescents: Data from patients of a regional referral center for hereditary endocrine tumors

et al. 2017

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Purpose To retrospectively evaluate the age of onset of MEN1-associated lesions in a group of affected children and adolescents and to compare the clinical features of our series with the evidence derived from the literature. Methods The study population consisted of 22 Italian children and adolescents (age 6-31 years at the time of the inclusion in this study) all with a clinical and/or a genetic diagnosis of MEN1 performed before the age of 16 who have been followed-up regularly from 1998 to 2016 at the Regional Referral Center for Hereditary Endocrine Tumors. Clinical, biochemical, imaging and genetic data have been collected for each patient. Results Ten subjects (45.5%) have not yet presented any clinical/biochemical/radiological manifestation of MEN1 disease, whereas 12 patients (54.5%) developed at least one MEN1-associated endocrine manifestation. The second group of patients was significantly older than the first one. The most frequent manifestation was primary hyperparathyroidism (50%), followed by pituitary tumors (prolactinomas) (31.8%) and nonfunctioning pancreatic neuroendocrine tumors (9%). The earliest cases of primary hyperparathyroidism and prolactinoma were a 12-year-old girl and a 13-year-old boy, respectively. Conclusions MEN1 disease seems to present with different features in children and adolescents from those in adults.Our study confirms the fundamental importance of screening for tumors in young MEN1 patients beginning in early childhood, in order to avoid diagnostic and therapeutic delays.

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Italian Society of Endocrinology Consensus Statement: definition, evaluation and management of patients with mild primary hyperparathyroidism

Cited by 46 publications

References 89 publications

Serum Calcium to Phosphorous (Ca/P) Ratio Is a Simple, Inexpensive, and Accurate Tool in the Diagnosis of Primary Hyperparathyroidism

Serum Calcium to Phosphorous (Ca/P) Ratio Is a Simple, Inexpensive, and Accurate Tool in the Diagnosis of Primary Hyperparathyroidism

MECHANISMS IN ENDOCRINOLOGY: Kidney involvement in patients with primary hyperparathyroidism: an update on clinical and molecular aspects

MEN1 in children and adolescents: Data from patients of a regional referral center for hereditary endocrine tumors

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